Page 191 State Telehealth Laws and Reimbursement Policies A Comprehensive Scan of the 50 States and District of Columbia

Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

metropolitan area;
• The referring provider may bill for an office,
outpatient, or inpatient evaluation and
management (E&M) service that precedes the
consultation, and for other Medicaid-covered
services the consultant orders, or for services
unrelated to the medical problem for which the
consult was requested. However, the referring
provider may not bill for a second visit for
activities provided during the consult;
• The consultant must be in control of the
member‘s medical examination, with the
referring provider participating, as needed. The
patient must be present in real time, and
telecommunication technology must allow the
consultant to conduct a medical exam;
• The consultant must provide the referring
physician with a written report;
• Separate payment is not made for the review
and interpretation of medical records;
• Coverage is limited to professional
consultations that meet the criteria.

Source: WV Dept. of Health and Human Svcs., Medicaid Provider
Manual, Chapter–519 Covered Svcs., Limitations, And Exclusions
For Practitioner Svcs. – Including Physicians, Physician
Assistants, And Advanced Registered Nurse Practitioners, p. 25
(Jan. 16, 2012).

Exercise and nutrition services may be delivered
through a single site, or between two sites, with a formal
agreement between the two parties.

Source: WV Dept. of Health and Human Svcs., Medicaid Provider
Manual, Chapter 527: Mountain Health Choices, p. 37 (Jan. 30,
2009).

For facility-based fitness centers/certified trainer
services, rural clinics may partner with a single-site
provider to utilize their professional services. Scheduled
appointments are then set up and video
teleconferencing is used to deliver services to the
member with at minimum a nurse present with the
member during the consultation.

Source: WV Dept. of Health and Human Svcs., Medicaid Provider
Manual, Chapter 527: Mountain Health Choices, p. 40 (Jan. 30,
2009).

Targeted case management can be conducted through
telemedicine with the exception of the required 90 day
face-to-face encounter with the targeted case manager.

Source: WV Dept. of Health and Human Svcs., Medicaid Provider
Manual, Chapter 523: Targeted Case Management, p. 11 (Jan. 1,
2013).

WV Medicaid encourages providers to render services
via telehealth in the Behavioral Health Clinic Services

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